Two hospital workers have lifted the lid on what it’s like to work on an an intensive care ward after the second wave of the pandemic has left Leicester’s hospitals with their highest ever number of Covid-19 patients.
Professor Sanjay Agrawal, a consultant in respiratory and ICU medicine and Kirstie Hill, an intensive care nurse have both spent months caring for the poorliest Covid patients, seeing first hand the death and devastation the disease can cause.
And they have told LeicestershireLive they are now preparing for ‘things to get worse before they get better’.
Leicester Royal Infirmary, Leicester General Hospital and Glenfield Hospital are under increasing pressure, but both medics say they firmly believe we are now nearer the end of the pandemic than the start.
“Catching Covid now would be like being shot on the last day of the war,” Sanjay said. “There is an end in sight, the vaccine is here and being given and what people need to do to prevent catching and spreading it is clear.
“There have been lots of messages throughout this but it really is as simple as stay home, protect the NHS, save lives. It makes sense and at the moment that is what we need people to do.”
Kirstie added: “I was filling in some forms of a patient the other week and their date of birth was after mine, I’m only 32. “The patient died, I think people need to hear that to realise that it’s not just old people dying and suffering.
“We’ve had people of all ages that we are looking after but looking after someone who was younger than me was tough. It hits home how serious this is.”
Leicester’s hospitals came within days of being Covid free in the autumn. Medics were on course to discharge the last coronavirus positive patient, but before that could happen, more were admitted. Since then they haven’t stopped coming through the doors.
Sanjay said the short time when the ICU was free of Covid patients feels like a ‘distant memory’ now as people suffering the effects of the virus now fill the wards.
He added: “These days we don’t have patients for routine surgery that we’d normally have. The key point to that is that they are still out there, they still need the treatment they are waiting for. Sometimes as concerning to us as the patients we are seeing are the ones we are not.”
Hospital bosses insist patients needing treatments should still be accessing hospitals and treatment, making appointments and seeking advice about any concerns that they have.
For the staff on the ICU, the emotional, mental and physical challenges keep coming.
Head to toe PPE is essential for staff and patient safety, but it does make simple tasks more demanding though.
“You can take the PPE off, but you can’t turn off your feelings,” Kirstie said.
Sanjay added: “For the nurses, it’s particularly hard, for them it’s a full 12/13-hour shift spent in full PPE, apart from designated breaks.
“Their whole time is spent on the ward, on their feet, in full PPE.
“It’s very hot, it’s uncomfortable and it can be hard to hear people and to communicate without being able to see them properly.
“We’re largely used to it now but it is a huge relief when you can take it off at the end of a shift.”
“When people come to us they are conscious, they are worried, they are alone,” Sanjay says.
“They know what ICU means and there are often very difficult conversations that take place.
“Because we can’t have visitors there are video calls and FaceTime for those who can speak to loved ones.
“For patients that aren’t able to communicate, we update families, but it really is very difficult for them.
“We as clinicians miss family members being on the ward, because of infection risk that can’t happen but it must be terrible for families to be waiting for phone calls and information.”
Kirstie added: “Patients come up to us and they are awake, you wheel them past people laying on their fronts, or wired up to machines and you see the fear in their eyes, knowing they are coming to us, they know what that means.
“You try and give them a reassuring look or a hand touch but you can’t take that fear away.
“Patients are awake for longer, they need us for longer but that means we build up a rapport with them before they might need to be put on a ventilator. It is heartbreaking.”
As well as the higher number of patients, medics have lower staff numbers to contend with, due to the amount of their colleagues who are in self isolation.
But Sanjay added that they are managing to cope at the moment.
“I think there is a vision that people have that because we say we are under pressure that things are chaotic but that’s not the case in ICU,” he said. “We are busy, we are full, we have lots of patients and that means lots of staff but it’s not people running up and down corridors, rushing around, it’s calm, measured, quiet,” Sanjay said.
“We are coping, but we know things are going to get worse and that’s always in the back of your mind.”
Both say it’s impossible to forget about their work, even when they are off duty.
Kirstie says: “It’s difficult not to think what if it were my mum, dad, brother, sister. I think that’s natural, you can’t not think that way.
“Nurses are people people, that’s why we do the job, you can’t just switch that off.
“Even at home it’s in your face, Covid is on the news, you talk about it with family and friends, there’s no getting away from it.
“Some days you have good shifts with positive outcomes and patients being discharged and others are the opposite.
“I have nightmares, I wake up in the night. I’m not saying that for sympathy, it’s the reality, the things you see and experience stay with you, it’s impossible not to take them home.”
Sanjay says: “Everyone is different, speaking for myself, I do think about individual patients, everyone we treat is a son, daughter, wife, husband, parent, grandparent, sibling, and at home worried are their families, unable to visit them.
“But I also think about capacity, the practicalities and knowing that we are full and wondering where we will put the patients we know will arrive in the coming weeks and days.”
“You still can’t help but wonder things like where will the virus take us next?”
“The first wave did teach us a lot and this time it feels as though there are known unknowns, we are more familiar with the pattern of disease, there are treatments, methods now that we can use, but they are not cures.”
Kirstie added: “During the first wave, there was the adrenaline but that doesn’t last forever. You can’t run on adrenaline for a year.
“It is different this time, we know what’s coming, we know the patterns patients follow, we know what comes next and at the moment we know it’s going to get worse.”
Both say it’s frustrating to see and hear people not grasping the reality of the situation.
Sanjay’s said: “The stay home, protect the NHS, save lives message is more important now than ever. If people want to know how they can help, that’s it. It’s as simple as staying home. The more people do, the less opportunity the virus has to spread.
“What people do today has a direct impact on what the hospital and ICU looks like in a couple of weeks’ time. The direct link is there.
“The death counts are up and I think people are almost desensitised but it’s worth stopping and thinking about more than 1,000 people, in one day, killed by one thing. It’s a huge number of people.
“People need to understand that this is very real, it’s going to get worse and it could be their loved one we end up caring for if they are not careful.”
“It’s true to say the older you are the greater the risk, but on ICU we are treating patients I don’t consider to be old. Many people in their 30s, 40s, 50s, 60s, are becoming critically ill and some are dying from this virus – the disease has no boundaries.
“Even those who do not become critically ill continue to suffer the effects for some time after having it.”
On those empty hospital videos and the conspiracy theorists, Kirstie answers their questions, with her own?
“Why would we lie? What do we have to gain from telling people just how horrible this virus is and how hard work is?” she asks.
“Believe us when we say this is real, it really is.”